Saturday, 29 September 2012

Off-the-couch mental health therapies

Off-the-couch mental health therapies

New research brings new approaches. Here's a look at four fields:
mindfulness practice, guided imagery, somatic experiencing and eye movement
desensitization and reprocessing.

A free weekly mindfulness meditation
convenes in the theater at the Hammer Museum, led by Diana Winston. (Katie
Falkenberg, For the Los Angeles Times)

By Lily
Dayton

September 29,
2012

When you think of psychotherapy,
the first image that comes to mind might be one of a distressed patient lying on
a couch, talking, while a desk-bound therapist takes notes. But while
traditional talk therapy can help people struggling with depression,
anxiety and the
stresses of daily life, the latest research on the brain and the mind-body
connection has sparked a proliferation of approaches that may reach deeper
levels of emotional healing than talking alone.

"Talk therapy is actually a little removed," says Dr. Martin Rossman,
clinical professor at UC San Francisco Medical School. "A story might relate
some of our disturbing experiences, but it can distance us from real emotions
and somatic [body] feelings."

Talking takes place in the cognitive, or "thinking," part of the brain, and
our thoughts are often the problem, adds Wolf Mehling, a physician at UCSF's
Osher Center for Integrative Medicine. To help combat negative or obsessive
thinking, many new therapeutic approaches focus on letting go of thoughts and
becoming anchored into bodily sensations.

Though alternative treatments will probably never
replace traditional talk therapy, new psychotherapeutic approaches can be used
in conjunction with talk therapy to help people achieve optimal mental
health, says Don Hanlon Johnson, professor of somatic psychology
at the California Institute of Integral Studies in San Francisco.

The bottom line, says Johnson, is that "we need all the help we can get. If
you look at the entire population, what helps one person doesn't always help
another. So we need many avenues to psychological, physical and spiritual
well-being."

Alternative treatments run the gamut from techniques that are championed by
mainstream mental health professionals to practices that are more in the
"fringe" realm of meridian-tapping and energy work. Here is a glimpse into four
of the more widely accepted nontraditional approaches, each with an element of
mind-body awareness:

Mindfulness practiceWhat it is: Rooted in Buddhist meditation techniques,
mindfulness practice has become accepted among many Western mental health
professionals as a powerful psychological tool. The practice is usually taught
in a group, in which people learn to focus on their breath and body sensations
in moment-to-moment awareness.

How it can help: Studies have
demonstrated that it can alleviate symptoms of depression and anxiety and that
it may help prevent depression relapse. It's also been shown to reduce feelings
of stress
and loneliness, help manage chronic pain and increase success rates of addiction
recovery.

What the experts say: "Focusing on the present moment
eliminates ruminating thoughts based on past experiences or anxiety about the
future," says Mehling. "You allow yourself to get space between the perception
and your interpretation. It helps you to distinguish thoughts from reality."
This process can also help with impulse control, Johnson says. "Many problems
are rooted in the fact that we're dissociated and unaware of our bodily response
to things. People aren't aware of harmful impulses until they get out of hand.
So mindfulness practice is about teaching people to slow down and notice when
impulses arise."Guided imageryWhat it is: Guided imagery is a mind-body technique that
teaches people to use their imaginations to achieve a relaxed, focused state.
Under the guidance of a therapist or CD, listeners use their senses to evoke
positive, safe, relaxing images.

How it can help: The idea is that the body and mind will
respond to images as if they are reality. If you imagine sucking on a lemon,
chances are your mouth will water as if you are actually tasting a lemon. Much
in the same way, people respond to comforting or relaxing images by experiencing
feelings of increased well-being.

Research has shown that people who practice guided
imagery have lower levels of the stress hormone cortisol
and an overall decrease in depression, anxiety and fatigue. Guided imagery may
also help motivate people to make positive life changes, such as losing weight
or starting an exercise routine.

What the experts say: "The ability of imagery to connect
with emotions — the way an experience actually feels in the body — is what makes
it such a great therapeutic tool," says Rossman, who explains that images can be
powerful catalysts for psychological change because they are formed in the more
primal, emotional parts of the brain. He adds, "Imagery is the natural language
of the unconscious mind — and it's the unconscious mind that we need to deal
with in deep psychotherapy."Somatic experiencingWhat it is: Somatic experiencing is a body-focused
intervention used to discharge tension that is stored in the body following a
traumatic event. The therapist directs the patient to revisit the event in small
doses while focusing on body sensations, guiding the patient to shift focus back
and forth between the traumatic memory and an image of comfort and safety. As
fears dissipate throughout the patient's body, gentle touch or movement is used
to help ground the person in the present moment.

How it can help: Somatic
experiencing is believed to regulate the involuntary nervous system, the network
that's responsible for the body's "fight or flight" and "rest" responses. There
have been a handful of studies that show promising results. A 2009 study looking
at social service workers involved in hurricanes Katrina and Rita showed that
those who underwent somatic experiencing showed decreased symptoms of post-traumatic
stress disorder (PTSD). Somatic experiencing has also been used successfully
with victims of other natural disasters, automobile accidents and abuse.

What the experts say: "The practice of somatics is extremely
effective in trauma recovery," says Johnson, who has worked with victims of
political torture. "Often the trauma is so physical that, unless the physical
dimension is directly addressed, healing can't be effective."Eye movement desensitization and reprocessingWhat it is: In a typical session of eye movement
desensitization and reprocessing (EMDR), a patient revisits traumatic memories
while following a pendulating object (such as a therapist's waving finger) with
the eyes. Originally developed to help veterans who suffered from PTSD,
clinicians now use the therapy to treat such problems as anxiety and addiction.
Frequently, the eye movements are replaced with audio tones alternating in each
ear through headphones. The treatment also incorporates other mind-body
approaches, such as focusing on body sensations and evoking images of positive
resources that can help the patient work through disturbing events.

How it can help: The idea is that EMDR causes the brain to
reprocess traumatic memories so they no longer function as emotional triggers.
Though there is evidence that EMDR reduces symptoms of PTSD, the mechanism for
how it works is still unknown. One prevailing theory is that focusing on two
things at the same time taxes the brain's working memory, causing the disturbing
image to become less vivid and less emotionally intense.

What the experts say: When a traumatic memory is
incompletely processed, "it's like the train went off the neural track and is
stuck," says Janis Clark, a Monterey-area psychotherapist specializing in EMDR.
"Once the memory is completely processed, it's no longer stuck. The previously
disturbing event moves from the emotional [region] of the brain to the long-term
memory. You still remember the horrible event, but it doesn't disturb you
anymore."